Menopause international最新文献

Objective: To evaluate knowledge of vaginal atrophy among postmenopausal women (aged 55-65 years), using the Vaginal Health: Insights, Views & Attitudes (VIVA) survey.

Methods: An independent research organization conducted a quantitative Internet-based survey, to obtain information from 3520 women who were living in the UK, the USA, Canada, Sweden, Denmark, Finland or Norway. Findings from Canada are presented (n = 500).

Results: Almost half of Canadian respondents had experienced vaginal discomfort since they had stopped menstruating, most commonly (88%) vaginal dryness; over half (56%) reported having experienced symptoms for three years or longer. Seven percent would have attributed vaginal symptoms to vaginal atrophy. Eighty-two percent of women felt that vaginal discomfort would have a negative impact on various aspects of their lives, most notably sexual intimacy (72%), 'having a loving relationship with a partner' (39%) and 'overall quality of life' (30%). While the majority of women (66%) who had experienced vaginal atrophy eventually sought the assistance of a health-care professional, a considerable proportion (34%) did not. Most women (58%) had tried lubricating gels and creams to treat their symptoms, but many were less aware of specific means of treating the underlying cause. However, compared with systemic hormone replacement therapy, more women indicated that they would consider local estrogen therapy (e.g. vaginal tablets or creams).

Conclusions: These data indicate that many postmenopausal women in Canada have a low understanding of vaginal atrophy. Medical practitioners should proactively initiate dialogue about this chronic condition with their patients, and discuss appropriate treatment options.

As more women survive reproductive cancers, menopausal symptoms following treatment can be a significant problem affecting quality of life and wellbeing. Hormone replacement therapy may or may not be contraindicated. Women often receive conflicting information about their management from different specialists. The aim of this study, based in a regional menopause clinic, was to examine referral patterns and symptom profiles of women with cancer or at high risk of cancer; to identify areas of need where a more integrated approach to management might be required; and to reach a local consensus across disciplines involved in the care of these women regarding prescribing of hormonal therapies. A retrospective case record review of all women attending Edinburgh Menopause Clinic for one 12-month period in 2011/2012 for management of cancer-related menopausal symptoms was undertaken. The results of the review were discussed at a multidisciplinary meeting and regional guidance on the management of these women was agreed. There has been an immediate improvement in communication between departments and the quality of information received in referral letters.

Objective: It is estimated that there are almost half a million women living with or beyond a breast cancer diagnosis in the UK, often referred to as the breast cancer survivor population. We report on the setting up of a dedicated breast cancer and menopause symptoms service (BCMS), and present results from research undertaken with breast cancer survivors with the aim of obtaining their perspectives on the BCMS service.

Method: An action-oriented approach incorporating improvement science methodology has been used to help develop and drive changes to support a high standard of NHS patient care delivery for women with breast cancer within the BCMS setting. Evaluation was undertaken of this innovative service using qualitative methodology, and included discussion within a focus group setting, patient consent to record discussion, followed by thematic analysis of transcription.

Results: Women who have survived breast cancer identified a need for specialist support to help improve their quality of life, which is also affected by menopause type symptomology. This support can be provided within the BCMS service setting. Our recommendations are that the BCMS service model is incorporated into any regional or national breast cancer patient pathway and service redesign work in place.

Conclusions: Breast cancer survivors would support the setting up of a BCMS service, and would actively help raise awareness and market this service.

Endometrial cancer is the fourth most common female cancer in the UK and the most common gynaecological cancer. Quality of life and symptom control needs to be considered in women who enter a surgically induced menopause. Hormone replacement in this population has been controversial to date. The current evidence regarding the safety of estrogen only and combined hormone replacement therapy is discussed in this review. The use of topical vaginal therapies, alternate therapies and the current data regarding testosterone use for symptom control is also outlined.

The female predominance of polyarticular osteoarthritis (OA), and in particular the marked increase of OA in women after the menopause points to a likely involvement of female sex hormones in the maintenance of cartilage homeostasis. This perception has inspired many research groups to investigate the role of estrogens in the modulation of cartilage homeostasis with the ultimate aim to clarify whether estrogen replacement therapy (ERT) could provide benefits in preventing the rapid rise in the prevalence of OA in postmenopausal women. The effects of ERT and selective estrogen-receptor modulators on the joint in various experimental models have been investigated. Clinically, the effects of estrogens have been evaluated by post hoc analysis in clinical trials using biochemical markers of cartilage and bone degradation. Lastly, the Women's Health Initiative trial (WHI) investigated the effects of estrogens on the joint and joint replacements. Even though the exact mode of action still needs to be elucidated, the effect involves both direct and indirect mechanisms on the whole joint pathophysiology. Several animal models have demonstrated structural benefits of estrogens, as well as significant effects on joint inflammation. This is in complete alignment with clinical data using biochemical markers of joint degradation which demonstrated approximately 50% inhibition of cartilage destruction. These finding were recently validated in WHI, where women taking estrogens had significantly less joint replacement. In conclusion, the pleiotropic effect of estrogens on several different tissues may match the complicated aetiology of OA in some important aspects.